188362 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
i ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $372.80
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 313
'y .ate INDIANAPOLIS IN 46208 CHECK NUMBER: 188362
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4239039 238.80 GENERAL PROGRAM SUPPL
1082 4343000 134.00 TRAVEL FEES EXPENSE
Carmel o Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
1 �2 y2 3 es
(Ck Z- (o
7 q) 0 r�1 yZ3R '2C) 1
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: 2j 0
Employee Name (prinq v O)F)Q2 T)T
Address r 1 6 t a n 3B I n JUL 1 9 2010
Check
payable to: City, St, Zip LA b2 y 8_
N
Signature: Approved by: J
Date: Date:
Business Services Division. Revised 7 -7 -08
FILE: Shared \Administrative\Forins\Staff FormslEmployee Exp Reimb Request
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENFA AL FORM NG- 101 116)
MILEAGE CLAIM
TO
(GOVERNMENTAL uNIZ ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPAATIQ7fT OR INSMUTION)
DATE I FROM TO SPEEDOMETER AUTO )ZLEAGE READING Ani ES 6
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELER PEA MILE
j
3 00
AUTO LICENSE NO. L TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or officla highway mapa 7
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certi#y that the foregoing account is just and correct, that the amount claimed e y ue, a r 'owing all furl credit `1 a PO
and that no part f the same has been paid.
Date o
Z�T�
17 7 7; Tr7 117 7
JUL 5 2010
BY:
PRESCRIBE) BY STATE BOARD Or ACCOUNTS GFHFRAL FOR1111G. /01119667
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIM ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD, DEPABTFCDT OR INSTMYrION)
SPEEDOMETER mfus E
DATE FROM TO MILES
READING
2 a POINT NATURE OF BUSINESS TRAVELED
POINT START FINISH PER MILE
r
n
r n
C
r 1 r
r
c m r c 1
gC �r b
C� 4
C
L it v IV
AUTO LICENSE NO. C I T TAIS j i lU
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed fly due, or liowing all just credits r
end that no p rt lithe same has been paid.
Dat l
JUL 15 2 010 JU
BY...
PRESCRIBED HT STATE BOARD OF ACCOUNTS GENERAL FORM No. 101 (1985) 1/ V
MILEAGE CLAIM {/t
TO
(GOVERNMENTAL UNI'n
ON ACCOUNT OF APPROPRIATION NO. FOR
(Oii10E, HOA p�, OEPwRT\0':7fr pp 1N5nTUTlox)
SPEEDOMETER MIL ;E
DATE FROM TO READING A UTO
MILES
NATURE OF BUSINE56 TRAVELED
POINT POINT START FINISH PER 1„pyE
c e- i
n Fri
3 on
v
r o
ry
r Ci
L O
r
ro t p
r
C c n
i4 k C')
C
�.r,
7 V o
AUTO LICENSE NO. 1 Ia
TOTALS 5 2 Qo
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claims gaily dwing all j
and that no part of the sa a has been paid.
Date
L� 11 P, 17 77
JUL 1 20
P
BY:
ACCOUNTS PAYABLE VOUCHER
CITY Or CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
360926 Holton, •Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6129110 Reimb. Mileage 4/14 6129/10 134.00
7113110 Reimb. Program supplies 238.80
Total 372.80
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
372.80
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT#rrITLE AMOUNT Board Members
Dept#
1082 -6 Reimb. 4343000 134.00 1 hereby certify that the attached invoice(s), or
1082 -6 Reimb. 4239039 238.80 bill (s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
29-Jul 2010
`Pkalm
Signature
372.80 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund